Department of General Surgery, Zhejiang Hospital, Hangzhou, China.
Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China.
Respir Care. 2019 May;64(5):519-527. doi: 10.4187/respcare.06377. Epub 2019 Jan 22.
Lung ultrasound is a valuable imaging tool in the diagnosis of community-acquired pneumonia. However, its diagnostic accuracy in ventilator-associated pneumonia (VAP) has not been fully investigated. The aim of this study was to evaluate the diagnostic performance of the combination of a lung ultrasound with procalcitonin (PCT) in mechanically ventilated subjects with symptoms suggestive of pneumonia.
A prospective study of 124 subjects with suspected VAP in 2 multidisciplinary ICUs was conducted between December 2016 and October 2017. Lower respiratory tract specimens were collected from all the subjects at enrollment and on the following 3 d. PCT assays were performed within 1 h of enrollment. Lung ultrasound and then computed tomography of the chest were performed within 24 h to detect lung consolidations. The subjects were divided into VAP and non-VAP groups according to the results of a computed tomography of the chest and semi-quantitative culture of the lower respiratory tract sample.
A total of 124 subjects were included (48 in the VAP group and 76 in the non-VAP group). A positive lung ultrasound result combined with PCT of ≥0.25 ng/mL diagnosed VAP, with a sensitivity and specificity of 81.3 and 85.5%, respectively. The area under the receiver operating characteristic curve was significantly higher for lung ultrasound combined with PCT than for a white blood cell count, PCT, C-reactive protein, or Clinical Pulmonary Infection Score alone.
A combination of lung ultrasound and PCT was accurate in the diagnosis of VAP. Lung ultrasound is a useful lung-imaging tool to assist VAP diagnosis.
肺部超声在社区获得性肺炎的诊断中是一种有价值的影像学工具。然而，其在呼吸机相关性肺炎（VAP）中的诊断准确性尚未得到充分研究。本研究旨在评估肺部超声联合降钙素原（PCT）在有肺炎症状的机械通气患者中的诊断性能。
2016 年 12 月至 2017 年 10 月，在 2 个多学科重症监护病房进行了一项有 124 例疑似 VAP 患者的前瞻性研究。所有患者在入组时和接下来的 3 天内采集下呼吸道标本。在入组后 1 小时内进行 PCT 检测。在 24 小时内进行肺部超声和胸部计算机断层扫描，以检测肺部实变。根据胸部计算机断层扫描和下呼吸道样本半定量培养的结果，将患者分为 VAP 和非 VAP 组。
共纳入 124 例患者（VAP 组 48 例，非 VAP 组 76 例）。阳性肺部超声结果联合 PCT≥0.25ng/ml 可诊断 VAP，其敏感性和特异性分别为 81.3%和 85.5%。与白细胞计数、PCT、C 反应蛋白或临床肺部感染评分单独使用相比，肺部超声联合 PCT 的受试者工作特征曲线下面积显著更高。
肺部超声联合 PCT 对 VAP 的诊断具有较高的准确性。肺部超声是一种辅助 VAP 诊断的有用的肺部成像工具。
